Adolescent homelessness is a national concern. According to a survey, based on a representative national sample, 7.6% of adolescents have been homeless at some time in the previous year [1
]. Homeless youth are known to engage in risky sexual behaviors [2
] that increase their risk for sexually transmitted diseases (STDs) and human immunodeficiency virus (HIV). Some homeless youth may be at additional risk due to their history of childhood sexual abuse, early sexual debut, depression, alcohol and drug abuse, living on the street, as well as a lack of connectedness to trusted adults and family [2
]. In addition, previous studies report that sexual risk behaviors vary by gender and by sexual orientation. Homeless adolescent females compared to males, engage in more sex acts [5
], are more likely to trade sex for money, food, drugs, or shelter [6
], and are less likely to use condoms [7
]. Homeless young males who have sex with other males report having more sexual partners than males who have sex with females only [7
]. Most studies to date on homeless youth sexual risk behaviors have been cross-sectional and not longitudinal studies. While the previous studies mentioned have examined the association between homeless youth individual factors and their association with sexual risk, few studies have examined the association between structural factors (living situation) and sexual risk behaviors. Therefore, the goal of this study is to longitudinally examine the association between newly homeless youth (NHY) individual factors (sociodemographic characteristics, depression, substance use) and structural factors (living situation) with sexual risk behaviors.
NHY are distinguished from chronically homeless youth by the duration of time that they have spent away from home. NHY have been away from home for more than one day but less than six months [10
]. Knowledge about the characteristics of NHY has recently increased and it now known that the characteristics of these youth vary from those who are chronically homeless. NHY tend to return home by 12 months (65%) [11
], they typically leave home due to family conflict (not sexual abuse), and only 1.4% report trading sex for money, food, drugs, or shelter [12
]. Since a large percentage of newly homeless youth may return home by 12 months and since the living situation may change over time, with some youth remaining at home and others running away from home again, at a future time, a longitudinal evaluation of newly homeless youth may allow for an examination of the effect of living situation on sexual risk behaviors.
Previous studies on adults indicate that being homeless or living in unstable housing is a source of chronic stress where the stress of daily survival needs predominates and can supersede efforts to reduce HIV risk [8
]. According to one cross-sectional study on homeless youth that examined the effect of living situation on sexual risk, youth living in street were found to be more likely to engage in risky sexual behaviors than those living in shelters [2
]. However, to date, no study has examined the effect on sexual risk, over time, for homeless youth who return home. A need exists for longitudinal studies to consider the effect of living situations (returning home vs. remaining homeless) on NHY sexual risk behaviors to determine if sexual risk is indeed reduced for youth who return home.
Social Cognitive Theory [13
] suggests that complex behaviors (i.e, engaging in positive health practices to avoid disease) are associated with perceived self-efficacy (the belief that one can perform the desired behavior) and outcome expectancies (the belief that engaging in a particular behavior leads to the desired outcome). According to this theory, positive sexual health practices such as consistent use of condoms and sexual self-care behaviors, such as avoiding casual sex with multiple partners, represent one endpoint of a complex process that involves cognitive-perceptual factors (i.e. sexual knowledge, future time perspective, perceived health status, self-efficacy for using condoms, intentions to use condoms, perceived social support) and behavioral factors in assertive communication and help-seeking to avoid or manage STD symptoms. Based on Social Cognitive Theory [13
] and previous studies on homeless youth sexual risk behaviors [3
], for this study, two hypothesis will be evaluated: 1) youth living in housing situations without parental supervision and support will report more sexual partners and less condom use (for this study social support is implied by youth living with family members; actual social support was not measured); 2) youth who are substance abusers will report more sexual partners and less condom use.